Recycled Rotts Surrender Form

Recycled Rotts Surrender Form
Personal Information
Name (Required)

First NameLast Name
Email (Required)
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number Where We Can Contact You

Area CodePhone Number
Where Is The Dog Located?

In A ShelterAnimal Control FacilityRescued by ME personally and is staying with MEI owner the dog and it is still with me at this time
If None Of The Above, Please Provide Information About Where This Dog Is Located
If You Own The Dog, Please Tell Us Why In Detail Why You Must Surrender It.
How Long Has The Dog Been In Shelter/AC Custody?
If You Are Representing A Shelter/Animal Control Please Provide The Name Of The Organization, Location, and Contact Information Including Email Address and Phone Number
About The Dog
If you have more than one dog to surrender, please fill out one surrender form for each, making sure all owner information is on each form. If you are from ad animal control or shelter with several animals, fill out the "Other Comments" for each section below to describe the dogs. If we have any further questions, we will contact you.
Information About The Dog
Name Of Dog
Male or Female

MaleFemale
Age Of Dog ( Birth Date If Known Otherwise Provide Approximate Age
Purebred Rottweiler or Mix? (if dog is a mix, please provide other breeds mixed with)
Does The Dog Have a Tail

YesNo
Other Comments:
Dog General History
Please provide the following information to the best of your ability
Where Did You Originally Get/Purchase/Find The Dog?
If Purchased From A Breeder, Did You Sign A Contract Providing the Breeder Right-Of-First-Refusal?

YesNo
Have You Contacted The Breeder?

YesNo
Is This Dog AKC Registered?

YesNo
Do You Have The AKC Papers?

YesNo
Do You Have The Pedigree On This Dog?

YesNo
Is The Dog An Inside Or Outside Dog?

InsideOutside
Other Comments
Medical History
If you are the present owner of this dog, please provide information about the dog's medical care
Veterinarians Name, Location and Phone Number
Has This Dog Been Spayed Or Neutered?

YesNo
Has This Dog Been Tested For Heartworm?

YesNo
If Yes, Was The Test Positive Or Negative?

PositiveNegative
Is The Dog Currently on Heartworm Preventative?

YesNo
When Was the Last Date Preventative Was Given?
Is The Dog Current On All Vaccinations Including Rabies?

YesNo
Please Provide Other Details Of Known/Suspected Medical Conditions Of This Dog:
Other Comments
Behavior
Is This Dog Housebroken?

YesNo
Does This Dog:

Need To Be Confined in a CrateConfined To A Certain Area Of The HouseHas Run Of The House
Please Provide Further Information For Any Of The Above Answers
Will The Dog Allow You, And Your Vet, To Easily Examine It's Body Without Much Trouble?

YesNo
If No Please Explain:
How Does The Dog Behave Around?

FriendlyShyNervousDifficulty With MenDifficulty With WomanChildren
Please Explain Any Of Your Above Answers
Is The Dog Good And Well Socialized Around (check all that apply)

Other Male DogsOther Female DogsSmall DogsCatsOther Small Animals
Do You Feel The Dog Is Overly Protective About His Food/Treats/Toys?

YesNo
Please Tell Us About Other Behavior Issues This Dog May Have"
Other Comments
Obedience
Does Your Dog Have Knowledge Of Basic Commands (for example: sit, down stay, come etc
When On A Leash, Do You:

Walk The Dogor, Does The Dog Walk You
Has The Dog Had Formal Obedience Training? Please Explain.
Other Comments
How Did You Hear About Recycled Rotts?
We reserve the right to refuse acceptance of any dog. Acceptance is based on many criteria, one of the most important is space availability.If you are out of our area, we would suggest you contact a rescue in your area.

Please remember that Recycled Rotts cannot accept owner surrender rottweilers from all over the country. We concentrate on saving the rottweilers that need our help in the Chicago area, and they are in abundance so we are never without rottweilers to save. Even when you are in the Chicago area, Recycled Rotts gives priority to rotties that are presently in animal controls and shelters. Owner give ups are accepted only when space is available. You are welcome to fill out the surrender form, or call and leave a message on our voice mail. If you have not received a response within 48 hours, please consider the rescue full and we are unable to help at that time.

If you have found a rottie with a Recycled Rott tag or otherwise identified as a Recycled Rott please contact us immediately. For other stray rotties, please call your local animal control or shelter. Recycled Rotts is not authorized to pick up strays, nor do we have the facilities to house them.

NOTE: If the rottweiler you wish to surrender was placed in your home by us, Recycled Rotts Inc., it is NOT necessary to fill this form out. Just call/email us and leave a message: Recycled Rotts Contact Page or (630) 551-0729. It is written in your contract at the time of placement that we take our rottweilers back in the event you wish to surrender them.
I certify that the information provide on this form is true and correct. I understand that an physical evaluation of the dog by an experienced rescue volunteer, or licensed veterinarian, will be required before we accept surrender. If upon inspection we find that information contained in this surrender form to be fales, we retain the right to turn down acceptance of the surrender at anytime during the evaluation.
Signature
Date
Recycled Rotts Inc

PO Box 1082

Oswego, IL 60543

630-551-0729
Should be Empty:

Recycled Rotts Surrender Form

Personal Information

About The Dog

Information About The Dog

Dog General History

Medical History

Behavior

Obedience